A lateralized anterior flange improves femoral component bone coverage in current total knee prostheses

Background Poor femoral implant fit to resected bone surfaces recently has been the motivation for several new total knee arthroplasty implant designs. Implant overhang risks adverse soft-tissue interaction while uncovered cut bone surfaces (underhang) risks increased postoperative bleeding or development of heterotopic bone. Methods Femoral implant fit was studied systematically, and without the influence of surgical variation, by virtually implanting standard and narrow width femoral components (Bi-Surface 5) using preoperative computed tomography data for 150 varus osteoarthritic knees in Japanese patients. Overhang and underhang rates and bone widths were determined by gender. Results Narrow femoral components helped avoid or minimize overhang in most female and some male knees. Although anterior width in the narrow components closely matched female bone width, the femoral component was necessarily displaced laterally to avoid overhang in the anteromedial portion. Consequently, there was significant medial underhang in the distal and posterior zones. Conclusions Ideally, the anterior femoral flange should be shifted 2 to 2.5 mm laterally relative to the distal and posterior aspects to provide optimal femoral bone coverage in this prosthesis. The current study also confirmed that this modification can be generalized to the other two currently available “narrow type” prostheses. This geometric modification might allow surgeons to select a femoral component with slightly wider mediolateral dimensions in the distal and posterior aspects to minimize underhang, while eliminating anterior overhang. Level of Evidence III.